Health Safety Climate and Associations

Health Safety Climate and Associations Health Safety Climate and Associations Read and make a brief summary and Powerpoint of the article. The powerpoint doesn’t need to be extensive. Key points from the reading can be summarized to facilitate/moderate a discussion. If you don’t mind, having a discussion question or 2 at the end as well. The article is posted below. Thanks! Health Safety Climate and Associations gershon_et_al._2000_health_worker_safety_climate_safe_work_practices_and_incident_exposure.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Health Safety Climate and Associations . ARTICLES Hospital safety climate and its relationship with safe work practices and workplace exposure incidents Robyn R. M. Gershon, MHS, DrPHa Christine D. Karkashian, MAa James W. Grosch, PhDb Lawrence R. Murphy, PhDb Antonio Escamilla-Cejudo, MD, PhDa,c Patricia A. Flanagan, BAa Edward Bernacki, MD, MPHd Christine Kasting, MPHe Linda Martin, PhDe Baltimore, Maryland, Cincinnati, Ohio, Mexico City, Mexico, and Atlanta, Georgia Background: In the industrial setting, employee perceptions regarding their organization’s commitment to safety (ie, safety climate) have been shown to be important correlates to both the adoption and maintenance of safe work practices and to workplace injury rates. However, safety climate measures specific to the hospital setting have rarely been evaluated. This study was designed to develop a short and effective tool to measure hospital safety climate with respect to institutional commitment to bloodborne pathogen risk management programs and to assess the relationship between hospital safety climate and (1) employee compliance with safe work practices and (2) incidents of workplace exposure to blood and other body fluids. Methods: A questionnaire, which included 46 safety climate items, was developed and tested on a sample of 789 hospital-based health care workers at risk for bloodborne pathogen exposure incidents. Results: A 20-item hospital safety climate scale that measures hospitals’ commitment to bloodborne pathogen risk management programs was extracted through factor analysis from the 46 safety climate items. This new hospital safety climate scale subfactored into 6 different organizational dimensions: (1) senior management support for safety programs, (2) absence of workplace barriers to safe work practices, (3) cleanliness and orderliness of the work site, (4) minimal conflict and good communication among staff members, (5) frequent safety-related feedback/training by supervisors, and (6) availability of personal protective equipment and engineering controls. Of these, senior management support for safety programs, absence of workplace barriers to safe work practices, and cleanliness/orderliness of the work site were significantly related to compliance (P < .05). In addition, both senior management support for safety programs and frequent safety-related feedback/training were significantly related to workplace exposure incidents (P < .05). Thus the most significant finding in terms of enhancing compliance and reducing exposure incidents was the importance of the perception that senior management was supportive of the bloodborne pathogen safety program. Conclusions: Hospital safety climate with regards to bloodborne pathogens can be measured by using a short, 20-question scale that measures 6 separate dimensions. Whereas all 6 dimensions are essential elements of overall safety climate, 3 dimensions are significantly correlated with compliance, and 1 dimension (senior management support) is especially significant with regard to both compliance and exposure incidents. This short safety climate scale can be a useful tool for evaluating hospital employees’ perceptions regarding their organization’s bloodborne pathogens management program.Georgia State University Health Safety Climate and Associations Presentation Health Safety Climate and Associations . In addition, because this scale measures specific dimensions of the safety climate, it can be used to target problem areas and guide the development of intervention strategies to reduce occupational exposure incidents to blood and other body fluids. (AJIC Am J Infect Control 2000;28:211-21) From the Department of Environmental Health Sciences,a School of Public Health, The Johns Hopkins University, Baltimore; National Institute of Occupational Safety and Health,b Cincinnati; Instituto de Salud, Ambiente y Trabajo,c Mexico City, Mexico; The Johns Hopkins Medical Institutions,d Baltimore; The Centers for Disease Control and Prevention,e Atlanta. Supported by the Centers for Disease Control and Prevention/National Institute of Occupational Safety and Health. University, School of Public Health, Department of Environmental Health Sciences, 615 N Wolfe St, Mailstop 1102, Baltimore, MD 21205. Copyright © 2000 by the Association for Professionals in Infection Control and Epidemiology, Inc. 0196-6553/2000/$12.00 + 0 17/46/105288 doi:10.1067/mic.2000.105288 Reprint requests: Dr Robyn R. M. Gershon, The Johns Hopkins 211 AJIC 212 Gershon et al Fig 1. Influence of safety climate. Research has identified a wide range of biological, physical, and chemical hazards in the hospital work environment, and recent research has added biomechanical/ergonomic hazards to the list of harmful exposures.1-5 Another class of exposures in hospital environments could be labeled “nonphysical” or psychosocial, and perhaps the best known of these is job stress. Risk factors associated with job stress, such as rotating shift work, heavy workload, lack of autonomy/control, and poor supervision have been linked to worker ill health and an increased risk of workplace injuries.6-12 However, one class of psychosocial factors that has not received much attention in health care research is “organizational culture and climate,” which is created by the contextual or background factors, such as leadership style and institutional goals, that exist in all organizations and transcend the job/task level. Organizational culture provides the background against which day-to-day tasks are performed and exerts a powerful influence on worker perceptions of job characteristics and organizational functioning.13-16 An important example of organizational culture is “safety climate.” Safety climate refers to the “summary of perceptions that employees share about the safety of their work environment.”17 Employees’ safety-related perceptions are based on several factors, including management decision making, organizational safety norms and expectations, and safety practices, policies, and procedures. These factors all communicate an organization’s commitment to safety. Employees’ perceptions about safety are important because organizations with strong safety climates consistently report fewer workplace injuries June 2000 than do organizations with weak safety climates.18-19 Organizations with strong safety climates have fewer employee injuries not only because the workplace has well-developed and effective safety programs, but also because the very existence of these programs sends “cues” to employees regarding management’s commitment to safety. Georgia State University Health Safety Climate and Associations Presentation Health Safety Climate and Associations . Evidence shows that if the organization is serious about adherence to safe work practices, then employees are more likely to comply (Fig 1). In other words, a safe environment supports and reinforces individual safety behaviors, and this in turn further affects behavior because of the influence workers have on one another. As safety behaviors are adopted throughout an organization, increasing pressure is put on noncompliers to come “in line.” A good example of this effect is the pressure on health care workers to follow isolation precautions when caring for infectious patients. The converse of this is also true. For example, health care workers, especially those in positions of influence and power, who fail to follow infection control guidelines can have a chilling effect on their co-workers’ behavior. Most of our knowledge about safety climate comes from the manufacturing and heavy industry work settings where it was first studied.17 This early research identified several key aspects or components of safety climate, including management’s involvement in safety programs, high status and rank for safety officers, strong safety training and safety communications programs, orderly plant operations, good housekeeping, and an emphasis on recognition for safe performance rather than a reliance on punishment and enforcement.20-24 Whereas the recognition of the importance of safety climate to productivity, cost, quality, and employee satisfaction has been realized in some industrial sectors, health care has not given safety climate the same attention. Generally speaking, hospital employees’ perceptions regarding safety are rarely formally evaluated or considered during the design or updating of safety programs.25 This issue is particularly important for the health care workplace because recent studies have linked global measures of safety climate to employee compliance with safe work practices and to incidents of exposure to blood and other body fluids.26-29 Because exposure incidents, regardless of the outcome, may be extremely burdensome to employees as well as to organizations, improving our understanding of safety climate may have far-reaching implications.30-33 Safety climate may be growing in importance as the health care environment increasingly emphasizes reengineering, restructuring, and improved productivity. Hospital-based health care workers have to work harder and faster than ever within an environment of increased patient turnover, increased patient acuity levels, higher patient prevalence rates for infectious dis- AJIC Gershon et al 213 Volume 28, Number 3 eases, and less time available for training and educational programs (with a subsequent overreliance on self-study training packets).34-38 All of these factors may inadvertently increase the risk of exposure incidents for hospital employees, thereby making safety climate even more important in this time of change. To develop a simple, yet effective, measure of hospital safety climate that is specific for bloodborne pathogen management and to ascertain its relationship to safe work behavior and workplace blood and body fluid exposure, a cross-sectional survey of health care workers was conducted. testing to determine its validity and reliability. The survey measured 4 major constructs: (1) safety climate, (2) demographics, (3) self-reported compliance rates, and (4) exposure history. The final 5-page questionnaire contained 99 items and was written at a 12th-grade reading level. Georgia State University Health Safety Climate and Associations Presentation Health Safety Climate and Associations . There were 46 safety climate items included in the questionnaire, and these covered 9 major dimensions, which are detailed in Appendix A. Respondents answered each safety climate question by using a 5-point Likert scale (strongly agree to strongly disagree).39 METHODS Ten questions were used to obtain information on employees’ age, sex, education, occupation, work schedule, supervisory status, etc. Study sample In 1997, as part of a larger study on total quality management in hospitals, we collected questionnaire data on safety climate. A stratified sample of employees from a large (1000+ beds), urban research medical center with more than 200 separate clinical services and a level III trauma facility was selected from hospital departments considered at risk for blood and body fluid exposures (eg, critical care, pathology, surgical services, emergency department, and obstetrics and gynecology). The sample population was further stratified by job title (eg, clinical nurse, phlebotomist, and physician) so that, as much as was feasible, only employees with the highest risk for blood and body fluid exposure were selected. A total of 1240 questionnaires was mailed to employees’ work addresses. The mailing packet consisted of a cover letter, disclosure letter, consent form, questionnaire, and preaddressed return envelope. Several follow-up mailings were sent to nonresponders. All procedures involving human subjects were approved by The Johns Hopkins University School of Public Health Committee on Human Research and by the hospital’s committee on human subjects. Complete information on the safety climate questionnaire survey, including copies of coding information, may be obtained by writing the corresponding author (R. R. M. G). Study questionnaire A new study questionnaire was developed on the basis of our earlier research.27-29 The new questionnaire was guided by intensive qualitative data generating techniques such as focus groups, structured interviews, and work site surveys. In addition, preexisting safety climate scales were examined and, whenever possible, items from these scales were restructured and included in a working draft questionnaire. This draft survey was then subjected to cognitive testing and extensive pilot Demographics Compliance A well-defined and well-characterized 14-item Universal Precautions compliance scale, which we developed and tested previously in several earlier studies, was used to measure compliance.27-29 For the current study, “strict compliance” was defined as a “score” of ?80% for all the applicable items. Again, a 5-point Likert scale was used for responses.39 Exposure incident history Employees were asked about 4 types of blood and body fluid exposure incidents, including needlestick injuries, splashes to eyes or mouth, contacts with open wounds, and cuts with sharps objects. The employees were asked to report the number of each type of exposure incident they had experienced in the previous 6 months; at least one exposure would place them in the “exposed” group. Statistical analyses All analytical techniques were performed by using STATA statistical software (STATA 5.0, 1984, Stata Corporation, College Station, Texas). After data cleaning and editing procedures, 4 stages of statistical analyses were conducted. First, an array of descriptive statistics (frequency distributions, cross-tabulations, measures of central tendency, and dispersion) was performed.Georgia State University Health Safety Climate and Associations Presentation Health Safety Climate and Associations . At the second level of analysis, the 46-item safety climate construct was factor analyzed by using varimax rotation, and all factored subscales were normalized where necessary. Cronbach’s ? was calculated for each factor extracted.40 In the third stage, bivariate associations were performed to examine associations between each dimension of safety climate and demographic variables with 2 separate outcomes: compliance with safety practices at work and bloodborne exposure incidents. These associations were examined by AJIC 214 Gershon et al June 2000 Table 1. Demographic characteristics of responders to the questionaires Variable Sex Female Male Job category Nursing* Technician† Physician Hours per week <40 ?40 Supervisory status No Yes Education ?14 years >14 years Job tenure, y Age, y N Percentage of respondents 635 109 85.4 14.6 481 140 21 74.9 21.8 3.3 195 547 26.3 73.7 639 103 86.1 13.9 238 479 Sample mean = 7.9, 1-40 (range) Sample mean = 37.2, 20-64 (range) 33.2 66.8 *For example, registered nurses, licensed practical nurse, nurse practitioners. †For example, phlebotomists, medical technicians, radiologic technicians, surgical technicians. using simple logistic regression models. Finally, in the fourth stage, independent, stepwise multiple logistic regression models (ie, separate models for compliance and exposure incidents) were performed. Only variables that were found to be significantly associated at the bivariate level were included in the regression models. RESULTS Demographics Completed questionnaires were obtained from 789 employees (a response rate of 60%). The respondents were predominately women (85%), with a mean age of 37 years (range, 20-64). The majority of respondents were well educated (67% college educated) and employed as nurses (75%). The employees had an average of 8 years of job tenure (range, 1-40 years). The complete demographic profile of respondents is presented in Table 1. Safety climate The 46 safety climate questions were factor analyzed, and 6 separate factors were extracted: (1) demonstrable management support for safety programs (4 items, ? = .84), (2) the absence of hindrances to safe work practices (3 items, ? = .80), (3) availability of personal protective and engineering control equipment (2 items, ? = .78), (4) minimal conflict and good communication among staff members (3 items, ? = .74), (5) frequent safety-related feedback/training by supervisors (5 items, ? = .71), and (6) cleanliness and orderliness of the work site (3 items, ? = .73). The scale items that did not factor into reliable scales were eliminated from additional analyses. Exemplars for each of the safety climate factors or dimensions are shown in Table 2. It is noteworthy that employees gave the highest mean scores for the dimensions measuring personal protective and engineering control equipment availability, senior management support, and absence of job hindrances. Employees gave the lowest scores for departmental conflict and workplace cleanliness. Thus the hospital received very good scores for personal protection availability and poor scores for the physical work environment and for interpersonal communication. Compliance Respondents’ compliance with safety practices was generally quite good, with reported scores highest for proper disposal of biomedical waste (90%), proper disposal of sharps (93%), wearing disposable gloves when indicated (82%), and taking special care with sharp objects such as scalpels (92%). Georgia State University Health Safety Climate and Associations Presentation The lowest rates of compliance were reported for recapping contaminated needles (32% sometimes or more frequently recapped), wearing disposable face masks to prevent splashes to the face and mouth (36%), wearing protective eye shields (41%), and unscrewing needles from needle holders (59%). These rates show improvement over previously reported rates (for this hospital) with identical items.27 Compliance rates for each item are shown in Table 3. Exposure incidents Reported blood and body fluid exposure incidents were not uncommon; 67 employees (9% of all respondents) experienced a total of 104 needlesticks for the 6-month period before the study. About a third of the exposed employees reported experiencing two or more needlesticks within that period. Interestingly, respondents stated that 71% of all needlesticks were reported to the hospital’s Employee Health Clinic, a substantial increase over previously reported rates.27,41 A total of 81 employees (10% of all the respondents) experienced 97 splashes to the eyes or mouth. Of these, only 51% of the splashes were ever reported to the Employee Health Clinic. Twenty-five employees (3% of all the respondents) experienced 107 contacts with open wounds, and 21% of these incidents were actually reported to the Employee Health Clinic. Finally, 52 employees (7% of all the respondents) experienced 81 cuts with sharp objects; with only 33% ever reported to the Employee Health Clinic. Altogether, AJIC Gershon et al 215 Volume 28, Number 3 Table 2. The 20-item hospital safety climate scale defined by each of its six organizational dimensions (N = 789) Percentage responding “strongly agree” or “agree”* Factor Personal protective and engineering control equipment availability (Cronbach a = .78, mean = 8.9) 1. Sharp containers are readily accessible in my work area. 2. Disposable gloves are readily available in my work area. Management support (Cronbach a = .84, mean = 8.3) 3. The protection of workers from occupational exposures to HIV is a high priority with management where I work. 4. On my unit, all reasonable steps are taken to minimize hazardous job tasks and procedures. 5. Employees are encouraged to become involved in safety and health matters. 6. Managers on my unit do their part to insure employees protection from occupational HIV/AIDS. Absence of job hindrances (Cronbach a = .80, mean = 8.3) 7. My job duties do not often interfere with my being able to follow Universal Precautions. 8. I have enough time in my work to always follow Universal Precautions. 9. I usually do not have too much to do so that I can always follow Universal Precautions. Feedback/Training (Cronbach a = .71, mean = 7.8) 10. On my unit, unsafe work practices are corrected by supervisors. 11. My supervisor often discusses safe work practices with me. 12. I have had the opportunity to be properly trained to use personal protective equipment devices so that I can protect my … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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